Three months ago, I wrote about how the Cleveland Clinic had recently opened a clinic that dispensed herbal medicine according to traditional Chinese medicine (TCM) practice. As regular readers might expect, I was not particularly impressed or approving of this particular bit of infiltration of quackademic medicine into a major, generally well-respected academic medical center, particularly given some of the amazingly pseudoscientific treatments espoused by the naturopath who was running the clinic. I also pointed out that, although herbalism is the most plausible (or perhaps I should say the least implausible) of modalities commonly associated with “complementary and alternative medicine” (CAM) or “integrative medicine”, it still exhibits a number of problems, the biggest of which is what I like to call either the delivery problem or the bioavailability problem. In brief, herbs, when they work, are adulterated drugs. The active ingredient is usually a minor constituent, embedded in thousands of other constituents that make up herbs, and it’s almost impossible to control lot-to-lot consistency with respect to content or active ingredients given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition. To demonstrate the concept, I pointed out that it’s much safer and more predictable to administer digoxin to a patient who needs its activity on the heart than it would be for the patient to chew on some foxglove leaves, given that the therapeutic window (the difference between the doses needed to produce therapeutic effects and the lowest dose that will cause significant toxicity) is narrow.

Which brings me to medical marijuana, a.k.a. medical cannabis.
Before I continue, let me just state my position on marijuana, which is different than it was, say, 20 years ago. Today, I believe there’s no reason why marijuana shouldn’t be legalized and treated by states the same way as tobacco products and alcoholic beverages are; they should be heavily regulated and taxed. Among physicians, this appears to be a common view, at least if you can believe a poll I saw a while back (for which I can’t find the link, alas). It’s also, these days, more and more of a mainstream view. In any case, medical marijuana has been a topic I’ve been meaning to write about for a while, now, but my “Dug the Dog” tendencies have kept popping up over squirrels topics like the Food Babe, ketogenic diets for cancer, and a variety of other topics.

Medical marijuana arrived in my state in 2008, when the voters approved a measure permitting it. After some time for the state to draft regulations, the law was implemented, and I had the strange (to me at the time) experience of receiving notices about state regulations, requirements, and documentation should I wish to prescribe medical marijuana. Indeed, more than twenty states, plus the District of Columbia, have legalized medical marijuana. They’ve done so on the basis of a political movement among patients that make pot sound like a miracle drug that can help when no other intervention can. And it’s more than that. Medical cannabis has been touted as a near-panacea for everything from pain to chemotherapy-induced nausea to HIV- and cancer-induced cachexia to even curing cancer itself. Yes, there’s a lot of hype out there, and there are a lot of claims that sometimes go viral on various social media, even though the evidence to support the claims is often, to put it mildly, less than rigorous.

Indeed, the acceptance of medical marijuana appears to be far more driven by politics than it is by science, as was pointed out in a recent New York Times article about the impending legalization of medical cannabis in New York State:

New York moved last week to join 22 states in legalizing medical marijuana for patients with a diverse array of debilitating ailments, encompassing epilepsy and cancer, Crohn’s disease and Parkinson’s. Yet there is no rigorous scientific evidence that marijuana effectively treats the symptoms of many of the illnesses for which states have authorized its use.

Instead, experts say, lawmakers and the authors of public referendums have acted largely on the basis of animal studies and heart-wrenching anecdotes. The results have sometimes confounded doctors and researchers.

I note that this article was written over a week before the Governor signed New York’s medical marijuana bill into law, thus legalizing it in New York. The article then goes on to give several examples, such as Alzheimer’s disease, lupus, Sjogren’s syndrome, Tourette’s syndrome, Arnold-Chiari malformation and nail-patella syndrome, and in particular rheumatoid arthritis:

Yet there are no published trials of smoked marijuana in rheumatoid arthritis patients, said Dr. Mary-Ann Fitzcharles, a rheumatologist at McGill University who reviewed the evidence of the drug’s efficacy in treating rheumatic diseases. “When we look at herbal cannabis, we have zero evidence for efficacy,” she said. “Unfortunately this is being driven by regulatory authorities, not by sound clinical judgment.”

As is the case with so much herbalism—and, make no mistake, medical marijuana is the new, popular herbalism of the moment—claims have far outstripped the evidence. Also, as pointed out in the NYT article, even advocates of medical marijuana admit that “the state laws legalizing it did not result from careful reviews of the medical literature.”

That’s the understatement of the year! Reading advocate websites for medical marijuana, I ask myself if there’s any disease or condition the holy weed isn’t good for? Truly, we are talking belief over science!

Unfortunately, even famous doctors like Sanjay Gupta are getting in on the act with a report, “Cannabis Madness,” full of a lot of anecdotes and rhetoric about “policy against patients.” Again, I believe that marijuana should be legalized, regulated, and taxed, just like alcohol and tobacco. If marijuana is going to be approved for use as medicine rather than for recreational use, however, the standards of evidence it must meet should be no different than any other drug, and for the vast majority of indications for which it’s touted medical cannabis doesn’t even come close to meeting that standard.

The evidence

There are definitely chemicals with potential medicinal use in the marijuana. No one, even the most die-hard drug warrior, denies that. These compounds are called cannabinoids, which is a term that describes a family of complex molecules that bind to cannabinoid receptors, which are proteins on the surface of cells. There are two types of cannabinoid receptors, type 1 (CB1) and type 2 (CB2). These receptors are seven transmembrane G-protein coupled receptors (so named for the seven protein domains that span the membrane), a class of receptor I’m pretty familiar with, because one of the receptors I study is of the same class, which looks like this:

The details of how this happens aren’t essential for this particular post, but when these receptors are stimulated by the binding of cannabinoid molecules, including endocannabinoids (produced by mammals), plant cannabinoids (such as (−)-trans-Δ9-tetrahydrocannabinol, more commonly referred to by its abbreviation THC) produced by (for example) the cannabis plant, and synthetic cannabinoids (such as HU-210), downstream chemical signaling pathways are initiated from the receptor to the inside of the cell, thus producing the effects on the cell and organism. There is mounting evidence that there are more than two types of cannabinoid receptors. In any case, CB1 receptors are found widely in the central nervous system, where they modulate a variety of responses, and are also found in other parts of the body, for instance, the pituitary gland, thyroid gland, lungs, and kidney, as well as fat cells, muscle cells, liver cells, and in the digestive tract. CB2 receptors, on the other hand, are expressed primarily in the immune system, the gastrointestinal tract, and, to a much lesser extent than CB1 receptors, in the brain and have been implicated in modulation of immune responses. In particular, stimulating CB2 receptors cannabinoids could be potentially useful as anti-inflammatory drugs. Over the last couple of decades, endocannabinoids and cannabinoid receptors have been implicated a large variety of functions, including memory, pain, energy metabolism, and more. It is thus plausible that manipulation of cannabinoid signaling could have therapeutic effects in a variety of areas.

Unfortunately, one of the problems with medical marijuana, as noted in the NYT article is that enthusiasm for weed as a cure-all has far outstripped existing medical evidence. This disconnect between the existing evidence base ranges from thin to nonexistent, depending on the condition. One of the most frequent claims I see is that cannabis can be used to treat cancer. I’m not going to address that claim specifically in this post, except very briefly, because I think it’s a large enough topic to warrant its own post. Suffice to say that interesting preclinical studies have been exaggerated beyond all evidence, but nonetheless certain cannabinoids could have potential in the treatment of certain cancers. I might also review the evidence base for cannabinoids and autism, given how I’ve been seeing discussions of its use starting to pop up lately on the usual sites. In other words, stay tuned for parts two and three spread out over the next several weeks, whenever no squirrels distract Dug the Dog.

In all fairness, in this country, at least, studying the medicinal properties of marijuana and its constituents is not easy, given that it is currently an illegal drug, as was discussed in the NYT article. It’s not for lack of interest, but mainly because the law (and therefore the Drug Enforcement Agency) classifies it as a schedule 1 drug with “no currently accepted medical use.” Scientists who want to do research on marijuana and its constituents—particularly clinical trials—must register with the DEA and submit an investigational new drug (IND) application to the Food and Drug Administration for human trials. Moreover, the National Institute on Drug Abuse is the only supplier of legal, research-grade marijuana. On the other hand, while doing research on marijuana is difficult in this country, researchers in other countries that have long had much more lax laws and regulations should have an easier time of it.

Another issue is how to do a proper placebo control. Given that many of the conditions for which medical marijuana is touted are conditions with a large subjective symptomatic component, such as pain, nausea, fatigue, or lack of appetite, clinical studies of medical marijuana are going to require really good placebo controls. Given that at least one of the active components causes a high, it’s arguably even more difficult than in the case of, for instance, acupuncture, to design studies with adequate controls. That’s why most of the more rigorous studies have used specific purified cannabinoids. For example, in this study, a titanium pipe loaded with doses of THC varying potencies is used rather than plant, while this study of cannabis for neuropathic pain used high-dose cannabis, low-dose cannabis, and placebo cigarettes.

Be that as it may, let’s look at the evidence base for conditions for which medical marijuana might provide a benefit. Remember, again: I’m leaving out cancer and autism for another day. Leaving these aside, here are the potential medical uses for marijuana for which evidence exists that ranges from reasonably good to suggestive.

Chronic pain. It’s been known for a long time that cannabinoids modulate pain responses; so it’s plausible that either smoked marijuana or cannabinoids isolated from marijuana (or synthetic cannabinoids) could be useful for chronic pain. Fortunately, this is one of the more widely-studied uses for medical cannabis. For example, a recent review of uses of cannabinoids for the treatment of non-cancer pain concluded that there was evidence that cannabinoids are safe and modestly effective in neuropathic pain, citing preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. As is the case with most reviews, more study was recommended. This particular review included smoked cannabis, oromucosal extracts of cannabis based medicine, nabilone (a synthetic cannabinoid), dronabinol (a synthetic delta-9-THC), and a novel THC analogue. Most studies have only been short term, and adverse events have tended not to be serious. The current general recommendation is that cannaboids should probably not be used as first line agents “for conditions for which there are more supported and better-tolerated agents,” and adverse effects are not well studied.

Appetite stimulation. I’ve never smoked marijuana, but those who have, have told me about the “munchies,” something that anyone who’s ever seen a comedy in which characters smoke post has likely seen used as fodder for jokes. Given its ability to stimulate appetite, it is therefore plausible that medical cannabis might be useful for appetite stimulation in patients with cachexia due to cancer or HIV/AIDS. (Cachexia is the “wasting” that can occur in advanced cases of malignancy and AIDS, among other diseases.) Unfortunately, a recent Cochrane review noted variable outcomes and concluded that the “efficacy and safety of cannabis and cannabinoids in this setting is lacking” and noting no good evidence of long-term effects on AIDS-related mortality and morbidity. Regarding cancer cachexia, Peter Lipson noted several years ago a study that failed to find any benefit from cannabis extract for cancer-related cachexia, speculating that maybe the mechanisms that cause appetite suppression in cancer are different than the mechanisms by which cannabinoids modulate appetite.

Currently, there are few controlled trials cited at the NCI website, which, taken together, find that oral THC has variable effects on appetite stimulation and weight loss in patients with advanced malignancies and human immunodeficiency virus (HIV) infection. A PubMed review by yours truly also found the evidence rather sparse. For instance, this randomized trial testing cannabis extract (CE), THC, and placebo (PL) reported that “no differences in patients’ appetite or quality of life were found either between CE, THC, and PL or between CE and THC at the dosages investigated.” Another randomized trial comparing megestrol acetate (Megase) and dronabinol found that “megestrol acetate provided superior anorexia palliation among advanced cancer patients compared with dronabinol alone” and that “combination therapy did not appear to confer additional benefit.” A more recent small randomized trial tested THC versus placebo and found that “THC may be useful in the palliation of chemosensory alterations and to improve food enjoyment for cancer patients.” To be honest, I was shocked at how sparse the literature is covering this particular indication. Indeed, as the NCI notes, there are no randomized controlled trials of smoked cannabis for this indication in cancer patients.

Nausea/antiemetic. Despite many advances in anti-emetics (anti-nausea and vomiting) agents, cancer-induced nausea and vomiting (CINV) is still among the most troubling symptoms cancer patients face. There are two FDA-approved cannabis products for this indication, dronabinol and the synthetic cannabinoid nabilone. The NCI cites several clinical trials and meta-analyses finding that these two drugs are efficacious against CINV, and the National Comprehensive Cancer Network guidelines recommend these drugs as treatment for breakthrough nausea and vomiting due to chemotherapy. One systematic review from 2001 found that cannabinoids were slightly more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride, but were not more effective in patients already using large doses of antiemetic drugs. A more recent systematic review and meta-analysis found that cannabinoids were superior to conventional drugs but that “adverse effects were more intense and occurred more often among patients who used cannabinoids.” In children with cancer undergoing chemotherapy, a Cochrane systematic review concluded that “cannabinoids are probably effective but produce frequent side effects” and that the review “suggests that 5-HT(3) [seratonin] antagonists with dexamethasone added are effective in patients who are to receive highly emetogenic chemotherapy although the risk-benefit profile of additional steroid remains uncertain.”

Inflammatory bowel disease (IBD). Last fall, the first clinical trial of cannabis in IBD was reported by a group of Israeli researchers. It was a small trial (21 patients), in which subjects were assigned randomly to groups given cannabis, twice daily, in the form of cigarettes containing 115 mg of Δ9-tetrahydrocannabinol (THC) or placebo containing cannabis flowers from which the THC had been extracted. A clinical response was achieved in 10 of 11 patients receiving cannabis with THC and 4 of 10 in the placebo group. Overall, this was a small study, but intriguing. No difference in complete remissions between the groups was observed, but that could easily be because of the small numbers. As with many conditions, all one can conclude is that more research is needed.

There is, of course, a laundry list of other conditions. Cannabinoids have been shown to lower intraocular pressure, making them potentially useful for treating glaucoma, although using cannabis to treat glaucoma is impractical in the vast majority of patients (see below), and there exist better treatments. After that, other conditions for which medical cannabis is frequently recommended include schizophrenia, for which a Cochrane Review concludes that there is no good evidence for or against the use of cannabis for schizophrenia. For epilepsy, data from double-blind randomized controlled clinical trials is lacking, although clinical trials are finally being done.

Overall, the evidence base supporting medical cannabis use, from my interpretation, ranges from nonexistent (most indications) to suggestive (e.g., anti-inflammatory), to fairly good in one case (ant-emetic). However, most of the good clinical trials didn’t use marijuana cigarettes as most patients get them, but rather either purified cannabinoids (or synthetic analogues) or cannabis cigarettes spiked with varying amounts of THC. Indeed, all of these studies tend to suggest that purified drugs from cannabis or synthetic drugs based on compounds designed to mimic either endocannabinoids or cannabinoids from marijuana will be the future. I realize that that’s not what medical marijuana activists want to hear. I also realize that it is likely I will be lambasted as a “pharma shill” or as so “conventional” that I can’t think outside the box, but I’ve endured those attacks before when I’ve criticized other forms of herbalism—and, make no mistake, medical marijuana is herbalism. In any case, mine, I believe, is a reasonable interpretation of the currently existing medical literature.

Moreover, contrary to what advocates will claim, cannabis, particularly smoked cannabis, is not without adverse health effects, as was recently reviewed in the New England Journal of Medicine. Potential medical effects reported in long time users include motor vehicle collisions (not unreasonable to expect because driving while high is not a good idea), chronic bronchitis (not surprising as a result of smoke inhalation), schizophrenia (one wonders whether correlation really suggests causation here), depression, and addiction to other drugs, although the risk for cancer due to marijuana smoke appears to be much lower than with tobacco cigarettes. True, drug warriors and moralists will frequently exaggerate the risks in order to promote their agendas, but that doesn’t mean that cannabis is perfectly safe and doesn’t produce significant side effects or complications.

Then there’s the delivery problem.

Delivery, purity, highs

Let’s consider, for a moment, a generic herb that has medicinal properties. I began this post by briefly discussing the problems with herbs as medicine, but I didn’t discuss delivery. If one were to come up with a delivery method for an effective herb, one would be hard pressed to come up with a worse method than burning it and inhaling it. Consider the case of tobacco. The combustion of dried tobacco leaves produces a toxic stew of gases with carcinogenic effects. Of course, the main reason tobacco is so addictive is because it does have an active drug in it, specifically nicotine, which rapidly reaches the circulation through the alveolar sacs in the lungs. However, that nicotine is mixed with numerous combustion products that can cause cancer and contribute to the numerous other diseases to which smoking tobacco has been linked.

This brings us back to delivery. People have been using marijuana for the high and for medicinal purposes for a very long time, but cannabinoids were only first isolated from the plant in the 1940s, and the main active ingredient, (−)-trans-Δ9-tetrahydrocannabinol (THC), wasn’t discovered until the 1960s. Now, like the case with cigarette smoke and its delivery of nicotine to the bloodstream, the THC and other active cannabinoids delivered to the bloodstream through smoking marijuana are mixed in a similarly toxic stew of combustion products. While it is probably true that marijuana smoke is less carcinogenic than tobacco smoke, it has the same potential for respiratory irritation and deposits four times as much tar into the lungs as a typical cigarette, mainly because marijuana is usually smoked unfiltered. However, occasional marijuana use appears not to have a significant effect on lung function up to seven joint-years of lifetime exposure. (I chuckled when I read that term; it means one joint a day for seven years or one joint a week for 49 years). Of course, this hardly compares to a typical tobacco smoker, who smokes anywhere from a half pack to two packs a day (10-40 cigarettes), and those using medicinal marijuana can be expected to be smoking at least a couple of times a day. Medical cannabis advocates even basically admit that this is true.

In any case, if one were going to decide on a drug delivery device for cannabinoids, one could hardly design a worse device than burning the leaf and inhaling the gases, where the active drug is just one of hundreds of products of combustion, all loaded with particulate matter and tar. Sure, toking one joint a day probably doesn’t do appreciable lung damage in the intermediate term, but smoking one cigarette a day probably doesn’t either. In the case of glaucoma patients, a condition for which there is some evidence of efficacy, it’s been noted that patients would have to be toking up several times a day:

Since at least 2009, for instance, the American Glaucoma Society has said publicly that marijuana is an impractical way to treat glaucoma. While it does lower intraocular eye pressure, it works only for up to four hours, so patients would need to take it even in the middle of the night to achieve consistent reductions in pressure. Once-a-day eye drops work more predictably.

Yet glaucoma qualifies for treatment with medical marijuana in more than a dozen states, and is included in pending legislation in Ohio and Pennsylvania. At one point, it appeared in New York’s legislation, too.

What’s more, for some of the ailments, such as glaucoma, patients would have to toke up every three to four hours day and night to maintain therapeutic levels in the bloodstream or tissues. Routinely consuming that much weed would be incapacitating.

Clearly, even if marijuana is efficacious for some conditions, there are serious drawbacks to burning the plant and inhaling the smoke as a drug delivery system. Other problems exist, not the least of which are the psychoactive effects of THC, which cause much of the “high” that pot smoking produces. To paraphrase one of the ophthalmologists in the NYT, his 60-year-old patients with glaucoma don’t want to be stoned all the time to get the beneficial effect of medical marijuana. The high is a particular problem for children, but none of this has prevented parents with autistic children from claiming that pot can treat autism, complete with seemingly-heartwarming anecdotes. One can imagine the temptation to simply keep the child toking until he becomes mellow and more “manageable.”
Of course, medical marijuana being in essence herbalism, with the same claims for efficacy of the “whole plant” due to synergy of its ingredients and the same attitude that “natural is better,” it’s not surprising that the same problems exist that are routinely observed for any herb sold for medicinal purposes. These problems include as inconsistent potency and purity, adulteration with contaminants—or even questions of whether the plant being sold is actually what is being claimed. Indeed, a fascinating story that sounds very familiar to those of us who have been paying attention to adulterated herbs and supplements was published a month ago in The Seattle Times:

Tonani, 38, decided several years ago to try pot. And it has worked for her, she said, especially strains low in the psychedelic chemical THC and high in the non-psychoactive ingredient cannabidiol, known as CBD.

As a medical-marijuana patient, Tonani knows it can be hard to find the rare strains that don’t make you high — and it can be even harder to get the same kind of pot consistently.

Testing shows that some marijuana strains are not what they purport to be in name, chemical content and genetics. This is particularly concerning for patients seeking pot low in intoxicants and high in pain-relief or other therapeutic qualities.

One strain widely known for its high-CBD and popular among medical-marijuana patients is called Harlequin. But when Tonani and a leading Seattle pot-testing lab analyzed 22 samples of Harlequin from various growers and dispensaries, five of them were high in THC and had virtually no CBD, which means people trying to take medicine were just getting high instead.

Again, this is a very common problem with herbal medicines, and cannabis, when smoked or ingested as the plant, is an herbal medicine.

Medical cannabis: Politics versus science

There’s no doubt that what is driving the legalization of medical marijuana in so many states has far more to do with politics than with science. Right now, for all but a handful of conditions, the evidence is slim to nonexistent that cannabis has any use as a medicine, and those conditions, such as CINV and chronic pain, can often be treated more reliably with purified or synthesized active components. Moreover, for one condition for which there is reasonably good evidence for the efficacy of cannabis and/or cannabinoids, namely chronic pain, politicians are reluctant to approve medical marijuana, as described in the recent NYT article:

Often state legislators have been motivated not just by constituents in distress, but also by the desire to restrict access to limited patient populations so that legal marijuana does not become widely available as a recreational drug in their states.

For example, while there is research suggesting that marijuana alleviates certain kinds of chronic pain, Mr. Lang noted, legislators in Illinois were reluctant to legalize its use in such a broad patient population. The state’s list of qualifying conditions is lengthy partly because lawmakers tried instead to specify a number of diagnoses that result in pain, some quite rare.

“I’ll bet there are hundreds of conditions that cause pain, and now 30 are listed,” Karen O’Keefe, director of state policies at the Marijuana Policy Project, said of Illinois’s legislation.

So, for one indication for which there is reasonably good evidence for the use of cannabis, legislators in Illinois were reluctant to approve its use, while approving its use for a lot of indications for which there is no evidence to support them. Clearly, this is a policy area that cries out for better science, given how legislators are being swayed by anecdotes that do not demonstrate that cannabis is effective and stories of “persecution” for growing medical marijuana, rather than by well-designed randomized clinical trials. Add to that the conflict with currently existing federal law, which outlaws cannabis as a schedule I drug, and the political situation is a mess, making doing research to find out for what indications cannabinoids have efficacy much more difficult. Antidrug zealots hugely exaggerate the danger of pot smoking, while pro-medical marijuana zealots claim that “cannabis cures cancer.” (It doesn’t, as I will discuss in the next installment.)

THC has what doctors and researchers know as biphasic activity. “At low doses it has certain effects, and at high doses it has opposite effects,” Dr. ElSohly explains. “Somebody using to get high at the right dose will be calm, happy, getting the munchies, and all of that,” Dr. ElSohly says. Someone using at the right dose could see medicinal benefits, too. But take in too much THC, and you can become irritable, even psychotic. “There are more emergency room admissions today than ever because of marijuana use,” Dr. ElSohly says. “That’s simply because of the psychoactive side effects of the high THC content that the public uses.”

This makes standardization and getting the dose right more important for medical cannabis than for most other drugs, which is why I’m not enamored of smoking pot as a THC/CBD delivery system. At the risk of being too personal and “anecdotal,” I couldn’t smoke pot if I wanted to, for recreational or medicinal uses, whatever my feelings about its legalization. I can’t smoke cigarettes, either, and have never tried either pot or cigarettes. The reason is simple. Inhaling just secondhand smoke sends me into fits of coughing—and has since I was a child. Inhaling smoke directly into my lungs has been and still is more or less unthinkable. And I’d bet I’m not alone, either.

My personal sensitivities aside (which are obviously not shared by most people), I see two critical unaddressed questions with respect to cannabis. The first issue is standardization. I’m sorry, herbalists and pot smokers, but smoking a dried plant just isn’t it, particularly given the relatively low doses of active compound needed for optimal effects. That means pharmaceutical-grade material. If cannabis is a therapeutic drug, it should be treated like every other therapeutic drug and be subject to clinical trials. The second issue is comparative effectiveness research. It’s not enough just to say cannabis (or whatever cannabinoid drug or derivative you might wish to use) is “efficacious” against this disease or this condition. We need to know how efficacious it is compared to the existing standard of care. In most cases, even for indications for which there is evidence of efficacy, the existing evidence base suggests that cannabis is less effective than existing treatments, with the possible exception of its use as an antiemetic. Yet none of this sways the zealots, just as similar evidence with respect to other herbs doesn’t sway believers in herbalism. Meanwhile, medical cannabis is rapidly becoming big business.

That’s because cannabis is the new herbalism. With relatively few exceptions, it’s about belief first, and then trying to get the science to to support its magical properties.

Comments

Orac, what a breath of fresh air! Well written, accurate, and accurately representing the state of research. You continue to impress me writing on an area that I usually cringe about.

I’m a bit frustrated by other medical sources and skeptics who deal with cannabis from a pro-legalization perspective.

Here’s my position:
1. Medical uses should have no bearing on whether a drug can be used for recreation. Codeine makes a great cough syrup, but I don’t think that means it should be legal to sell at the local gas station or 7-11. Likewise, hydrocodone is an indispensable drug for pain management, but legalizing its use for recreation makes no sense. If cannabis has medical applications, let it be treated the way we treat prescription drugs. We shouldn’t mix and match and encourage self-medication.

2. Tobacco and alcohol are not legal because they are safe. Let’s keep reminding ourselves that, combined, these two legal drugs are involved in causing more preventable deaths than any other single factor. They are only legal because we lack the political will to make them illegal.

To me, this is no different than saying we should release any serial murderer who killed fewer people than Jack the Ripper, because that guy never served any jail time, so why should anyone else? Let each drug stand or fall on the merits and harms shown by research.

I’ll stop there. This is a sore issue for me. I’m a little frustrated with a lack of clear, rational thought on the issues around physicians encouraging the legalization of a recreational party drug. I appreciate this well-written article.

You never smoked marijuana? Well your GPA was probably a lot better than mine.
The irony for me was that when I was prescribed Marinol for weight gain I hated it. Threw all the pills out. When you are taking a lot of meds as I was at the time, the last thing you want is another med with central nervous system side effects. IMHO. Plus I never really was one for getting the munchies – but I sure loved music & art! Sometimes I kind of miss it when I go to concerts now. sigh.

This was a great post. My nephew has Dravet, and my mother was talking a few years ago about taking him to CO for cannabis oil. I think I talked her out of it based upon dosage/quality arguments learned here from our esteemed host (or perhaps that’s a bit egocentric-his mother may have simply nixed the idea). Been following epidiolox (sp?) for about a year now-they’ve opened up a trial in the midwest and that may be a possibility for my nephew if his neurologist agrees.

As much fun as this blog is, I rather miss some of our more “entertaining” visitors. I know Greg asked to be banned (still gives me the grins), but whatever happened to Augie, or Jen, or Sid? I know getting spanked isn’t fun, but their apparent decisions to leave us left a deficit in my daily dose of giggles.

Trying to ban stuff that can be grown (tobacco, pot, grain for alcohol) and then easily produced with household ingredients/equipment (alcohol, there might be more but I don’t know the facts there) is an enormous game of whack-a-mole that the moles definitely will win.

I’ve heard that synthetic pot is more dangerous than plant pot. Don’t know if it’s the usual anti-drug scaremongers, or if the unintended consequences have actually become a bigger problem than weed let well enough alone.

Disclosure: never been a user and I only say that to make clear I have no agenda other than wanting to see the end of the likes of the DEA and military involvement in stuff that is not in its charter. Way too much resources involved in chasing pot for no benefit and likely much harm.

I believe there’s a place in the world for healthful, non-medicine products. For example, my wife will drink a cup of coffee when she’s having asthma rather than jumping right to the emergency inhaler. Could that instead be an FDA regulated pure caffeine powder? Sure. But coffee works.

So certainly claims of Cancer and Glaucoma cures need to be treated as medicine and carefully studied with specifically extracted compounds. But if a cancer patient finds a pot brownie helps their nausea or appetite? Great! Even if it were just placebo, that’s still a good thing.

I think that’s where this confusion of marijuana and medicine comes in. It’s not that it needs to be a medicinal appetite stimulant, it’s that if a very sick person finds help in it, why not just let them consume it? Not as medicine, but as something fairly benign that helps them feel better. But since marijuana is illegal it needs to be couched in the terminology of medication to get a legal exemption for the individual. Which as you point out confuses the issue of what a medicine is.

I’ll reiterate some other commenters, this was a remarkably clear-headed piece on this topic.

I’m willing to believe that synthetic pot is more potent than plant pot. It’s easier to adjust the THC content of synthetic pot to what you want, and I would think[1] that for most users higher is better. Whether that’s more dangerous depends on your perspective. A user who is used to plant pot could be overwhelmed by a similar dose of the more potent synthetic pot. But with synthetic pot, at least for medicinal purposes, you know how much you need, unlike with plant pot where the potency can vary from negligible (ditch weed) to quite strong. The latter comes up with other herbal medicines: in synthetic form you know how much you are getting, whereas with grown product you are never sure.

I mostly agree with this but I think one of the reasons patients prefer to smoke is that it’s actually easier to control the dose then with a pill, such as Marinol. I think most people who use it for medicinal purposes probably just take a puff or two at a time, wait to gauge their reaction and then smoke a little more if needed. I had a friend with abdominal cancer who after surgery and chemotherapy decided to quit treatment. He said narcotic pain medicine made his pain worse because it constipated him. Pot and hot baths in his jacuzzi were the only things that helped. And anyone who smokes a whole joint of todays’ marijuana is hard core. I haven’t smoked in years, but once they came up with the powerful strains, i found one or two tokes was all I could handle. As far as nausea meds, at least some of them have potential extrapyramidal side effects. I believe they black boxed Reglan for this. And I think compazine and phenergan also have that potential. Don’t know about Zofran, though.

Some of the stuff sold as “synthetic pot” may not be the active ingredients in pot just derived synthetically. Some of the so-called “bath salts” are sold as synthetic pot.

How much they are really like the compounds in pot I don’t know (as last I heard on the news they are whichever designer drugs hasn’t been banned yet and as one gets banned a new compound gets put in the products). I assume they call the whatever they cooked up synthetic pot because people don’t think of pot as dangerous so it makes them more likely to buy it than whatever chemical they put in it this month.

One thing smoking ones pain drugs would do would be to normalise it, to make it social. Everyone i know on opiates, and these are prescribed ones, is under constant censure and judgement from others, often their family, for taking them. Even when the pills are all that allows them to function.
Turning pain relief into a fag break would help.

note for merkins…fag in English means cigarette. If fag break sounds odd to you think how the reference to a johnny sounded to me upthread. As a johnny is a prophylactic…

Well, those are “jimmies” here, but I think that’s mostly Black slang (as is “squares” for cigarettes, which seems to be falling out of use, although I still say it, sometimes to the surprise of the hearers; “that’s jail talk, man”).

I have personal experience and yes what I am going to do is provide an anecdote so keep that in mind.

I have cancer and have had chemotherapy for it. I did take cannabis to try and put a lid on my nausea. While it helped a bit it had no where near the effect that the anti emetics that were given to me did. Compared to Aprepitant it was pretty useless.

As for analgesia it works but for me it is no better than paracetamol. Codeine has a much greater effect. I know this as I also have Rheumatoid Arthritis. It is also claimed that cannabis is an effective anti inflammatory agent. Well compared to Celecoxib it really is ineffectual. As for modifying RA’s effect on the joints compared to methotrexate it is useless.

I am a member of a cancer support forum. We regularly get people on board who claim that cannabis is protective against cancer. I really find that hard to believe as I personally know stoners who ended up with cancer. What I really want to see is a large scale study that investigates the incidence of cancer in people who regularly use Cannabis for recreational purposes. I could then point to the study and shut them up. Mind you it is a support forum so any argument is short lived. it would be nice though to have some evidence to educate the clueless.

Someone commented on political will to make things illegal. Well we tried that in the 1920’s with alcohol and it was an unmitigated failure. Making things illegal does nothing but empower criminal organizations and turn decent citizens into criminals. We have had a war on drugs now for decades and nothing has happened except tens of thousands have died in drug related violence and the use of illegal drugs has skyrocketed. I applaud those countries and those states in the US who have made it legal for recreational purposes. Make them legal, tax them, then use the money in public health campaigns. It has worked for tobacco and it will work for cannabis, or any other illegal drug for that matter. In the US and Australia we have managed to get smoking rates down from over half of all men down to around 15%. We never had to resort to banning it and to do so I think would be counter productive.

So in passing if anyone can point to a large study showing cancer incidence in heavy cannabis users I would be most appreciative.

I challenge you to a public debate, you paid-for, antiscientific shill! Continue to help the Prohibitches withhold God’s healing plant and reap the karmic consequences…Repeal – Amnesty – Reparations! We will settle for nothing less. Respect existence or expect resistance

Yup. But if your point was “there must be something to it, or they’d never have gotten a patent granted” then you’re quite mistaken. Patents have been granted for many things that don’t do what they’re claimed to – for perpetual motion machines, or for infinite data compression methods (which, believe it or not, are actually more impossible than perpetual motion.)

>”Inhaling just secondhand smoke sends me into fits of coughing—and has since I was a child. Inhaling smoke directly into my lungs has been and still is more or less unthinkable. And I’d bet I’m not alone, either.”

Actually, unless you have allergies, asthma or some kind of respiratory condition, that’s VERY unusual. Most people can inhale smoke no problem.

Did smoking pot make you stupid, or were you stupid before you started to smoke it?

I ask this because I spent two hours a couple of days ago waiting for old Honda that was parked in my driveway to be removed by the police. Not just blocking the driveway, but backed to being not far from the garage. In the back seat was a bong, and the police officer told me it was a stolen car.

What kind of intelligent person steals a old small car and then backs it up a driveway, while leaving their stuff in the back? Needless to say, I am not impressed with that person’s cognitive function.

By the way I only smoked pot for a week in college because it gave me annoying “itchies”, and I did not like that it made me stupid. I also have a real verifiable allergy to nicotine, so I don’t like being around tobacco smoke. Or wood smoke. Or any other airborne particulates.

‘Most people can inhale smoke no problem.”

Really? Provide the PubMed indexed studies from qualified reputable researchers to prove otherwise. While we have had several in our family die from tobacco smoke inhalation (including a 42 year old who lost his jaw to cancer), I will only use the sixty plus years of epidemiological studies showing tobacco smoking is deadly.

Since pot smoking has only become legal in the past couple years in a few places, I predict there will be similar results from studies in the next forty years for marijuana.

By the way, I voted to legalize marijuana smoking in my state. I really don’t care what chemicals you inhale, I just don’t want doing it in my air space. Committing acts like stealing a car and abandoning it in someone’s driveway may or may not be the affect of smoking pot.

It just does not reflect well on the users. So please clean up that image, unlike this city attorney. You can start by being coherent.

Narad, you’ll have to take my skin tests results with the allergist MD who explained them to me. Personally I was glad in the late 1970s to have a verifiable piece of paper to bolster my annoyance at those who wanted to smoke tobacco in my presence.

That included my dorm roommate who chose a non-smoking room thinking it would help her quit. Oh, and the folks in movie theaters, and the woman seated in the nonsmoking section of the airplane, and the woman in our office who kept telling us how we should only eat organic food while sucking on a cigarette (so glad when the company went smoke free, and surprised when some tried to hide the lit cigs under their desks).

I just hope that we can convince the ones who wish to now legally smoke marijuana can be reminded that many of really find it annoying.

By the way, not all things that cause reactions are proteins. Though sometimes things that cause dermatitis do that as a combined reaction to items in the body, like nickel reacting to perspiration.

Note I was very upset that some idiot abandoned a stolen car with a bong in on my driveway that trapped me from driving somewhere before it closed. Plus waiting two hours after calling the police for it to be removed (had to resort to “911” after spending several minutes on hellish voice mail trying the “non-emergency” parking infraction police number).

That alone illustrates one reason why I detest the idiocy of folks like jacksvsworld. Oh, and pedantic comments that may follow. So if you’ll excuse me I will still think very little of the intellectual capability of anyone who says “people can inhale smoke no problem.”

Because it doesn’t take a rocket scientist (fortunately I used to be one) to know that it is not healthy to intentionally inhale particles contained in any kind of smoke.

There are patients that have beat cancer and other llife threatening disease with cannabis, most have not let the Dr’s give them the poison called chemo, they went straight to the oil made from the plant tha heals most anything it somes in contact with. With holding this plant from people (specially the seriously ill) is inhumane. Do your homework, there are tests showing the power of this plant , I have seen brain tumors gone with no evidence of cancer left after using the medical marijuana oil and eating a clean healthy diet. The most important thing you can do for yourself is to eat right, no GMO foods, no sugars etc and educate yourself on all the things this amazing plant can and does heal!

There are patients that have beat cancer and other llife threatening disease with cannabis, most have not let the Dr’s give them the poison called chemo, they went straight to the oil made from the plant tha heals most anything it somes in contact with. With holding this plant from people (specially the seriously ill) is inhumane. Do your homework, there are tests showing the power of this plant , I have seen brain tumors gone with no evidence of cancer left after using the medical marijuana oil and eating a clean healthy diet. The most important thing you can do for yourself is to eat right, no GMO foods, no sugars etc and educate yourself on all the things this amazing plant can and does heal!

Nice prohibitionist hit piece, Orac. You lose when your already name calling with terms like quackery in the first paragraph. See, I can spot this thinly veiled pseudo science, limited hangout, feces a mile away.

Just word search “Ceramide” in the article.

Hmmm ….. it`s not there, Orac. That means your either not a very good researcher, or an author with an agenda who is suppressing some very important info some of your readers may find helpful.

In the words of Dennis Hill Bio-Chemist who cured his prostate cancer with cannabis oil.

“In every cell there is a family of interconvertible sphingolipids that specifically manage the life and death of that cell. This profile of factors is called the “Sphingolipid Rheostat.” If endogenous ceramide (a signaling metabolite of sphingosine-1-phosphate) is high, then cell death (apoptosis) is imminent. If ceramide is low, the cell is strong in its vitality.

Very simply, when THC connects to the CB1 or CB2 cannabinoid receptor site on the cancer cell, it causes an increase in ceramide synthesis which drives cell death. A normal healthy cell does not produce ceramide in the presence of THC, thus is not affected by the cannabinoid.”

Cannabis, specifically THC, kills cancer Orac. There is zero doubt. It has been demonstrated endlessly for at least the last 20+ yrs. In a legalization debate, a retired DEA agent was forced to admit they knew of some 10,000 peer reviewed articles as of 2007. Who knows how many now.

And once a majority of world citizenry know this, the for-profit-not-for-healing big cancer industry is going to a multi-billion dollar financial hit.

Is that what your protecting Orac? Or are you just uninformed?

And Dennis Hills account is just one of countless Cannabis Therapy success stories. That`s why GW Pharmaceuticals applied for some 43 patent for various aspects of the production of their multi-spectrum medicine Sativex.

Do you really think the US gov. has multiple patents thru Health and Human Services for no reason?

Then, lets get one thing straight, so to speak. Smoking cannabis is a great way to get high, but a lousy way to take advantage of the super nutrient/medicinal value the plant has. It has to be eaten, preferably as a whole plant extract.

And then lets get another thing straight. We the People do not need, nor want any more research on this plant. It is the most researched plant in human history.

What we want is complete deregulation. Just like pre-1937. The world got along just fine with cannabis as it had for some 5000 years previous, and so far Colorado and Washington have proven it will be largely the same now.

We want to be able to grow this plant for any purpose we so desire. And since it is already well established that cannabis has an astronomical LD50 rating, we don`t need the medical/pharma complex to tell us what the proper dose is. After all their products, and dosing guidelines are responsible for many thousands of deaths and injury yearly. We`ll figure it out, thanks.

“Endogenous cannabinoids regulate the de novo synthesis of ceramides, lipid-based components of the cell membrane that perform both structural and signaling functions. It is becoming increasingly obvious that ceramide functions as a physiological signaling molecule, particularly with regard to the control of apoptosis, but also growth arrest, differentiation, cell migration, and adhesion.104 As such, the role and regulation of ceramide signaling is attracting increasing attention, and ceramide now has an accepted role in the development of some cancers.105 Activation of either CB1 or CB2 in glioma cells is associated with an increase in ceramide levels leading to the activation of the extracellular signal-regulated kinase (ERK) pathway via Raf-1 activation and p38 MAPK activation.14,106 Both these pathways ultimately cause apoptosis through caspase activation and/or cell-cycle arrest.14 In breast cancer cells, the CB1 antagonist SR141716 inhibited cell proliferation through the effects of ERK1/2 colocalized inside membrane lipid rafts/caveloae.59 Such rafts play a critical role in the growth and metastasis of breast tumors.107,108 A final component of the ERK pathway, p53, plays a crucial role in switching between cell-cycle arrest and apoptosis.109 In cultured cortical neurons, Δ9-THC activated p53 via the CB1 receptor, thereby activating the apoptotic cascade involving B-cell lymphoma (Bcl)-2 and Bcl-2-associated X protein, suggesting that the cannabinoid pathway ultimately causes cellular death via apoptosis.110″

You missed the conclusion from that paper you linked to, in which the authors say that we cannot move forward with cannabinoids as a cancer treatment without more research to resolve disagreements in the litarature. To wit:

Overall, the cannabinoids may show future promise in the treatment of cancer, but there are many significant hurdles to be overcome. There is much still to be learned about the action of the cannabinoids and the endocannabinoid system. The current disagreements in the literature suggest gaps remain in the knowledge base around the normal signaling pathways used by endocannabinoids, the physiological systems that are involved, and the range of effects that these compounds cause. Future research will help clarify the actions of the cannabinoids, and particularly the endocannabinoid signaling pathway, which will be critical in the ongoing development of these compounds.

It is a distinct possibility that the cannabinoids may have a place in the future treatment of cancer. Several reports have shown that the synthetic cannabinoids in particular have the potential to show sufficient specificity and efficacy to be precursors to clinical treatments. However, at this point in time, the results from studies are lacking sufficient depth of understanding to allow this transition to occur. The contradictory nature of reports around the efficacy of compounds highlights our lack of detailed understanding of mechanisms of action. The resolution of the conflicting evidence around cannabinoid action will continue to be a research priority in the near future, and it is expected that developing a more robust understanding of the mechanisms of action underlying cannabinoid action will facilitate the acceptance of cannabinoid use in a clinical setting.

“Dr. Donald Tashkin UCLA Geffen School of Medicine Pt 2 of 2. Conclusion of 2 part interview with the famous research doctor from UCLA Geffen School of Medicine. Pulmonary research on use of marijuana and interaction with the lungs was funded by the Federal Government to prove that lung cancer is caused by smoking marijuana, however the results proved cannabis does not cause lung cancer.”

Todd W ….. point taken. And absolutely, they can resolve the scientific differences til their blue in the face. No problem. After complete deregulation.

Because regardless of the exact science and bio-mechanisms involved, there is, and never was any credible justification for the prohibition of cannabis in the first place. That`s just a fact.

Prohibition is nothing more than the DEA enforced monopoly on what “We the People” can, and cannot, use for food, medicine, or to get high with if we so choose.

And fine, let the pharmaceutical industry have at it. If they want to make a cannabinoid profile certified whole plant treatment for any number of diseases, ala the GW Pharma approach, for say $2000 for a cancer treatment regime, that`s reasonable. Insurance could cover 75% and the patient could shell out $500 out of pocket. That would be a whole lot better than losing all your savings, your job, your house, everything, after a long, expensive, brutally torturous, and ineffective conventional treatment regime.

And some people will prefer that approach. But many of the rest of us are well acquainted with the various ways cannabis can be consumed as medicine and will continue to make and use it as we please, legal or not.

And unless the authorities_that_shouldn`t_be shut down the internet, it`s a genie that cannot be put back in the bottle.

There has been 50+ years of 100`s of millions of people smoking cannabis on a daily basis around the world. If the was any real threat of cancer, lung or otherwise, from cannabis, smoked, or eaten, the US Gov. would have been able to DEFINITIVELY prove it. Period.

It only took the gov, about 20 years to fully prove tobacco causes cancer, that despite the huge lobbying power of the cigarette industry.

They have not been able to prove a link to lung cancer because it does not exist.

Considering cannabis is mostly smoked in combination with tobacco and tobacco smoking raises the risks of getting lungcancer, it isn’t that weird that there might not be much research to prove cannabis raises the cancer risks. It is proven to raise the risks of getting a psychosis.

Now that it is legal in my state the idiots think they can smoke it anywhere. Even though the law explicitly states it must be done in private. And why do the dolts think that those of us who dislike smelling tobacco smoke think we would be okay dokay about sniffing the stench of their smoke?

Oh, and Danman, because the consumption of cannabis smoke was previously illegal, there could be no studies on lung issues. I suspect that the users may not be quite truthful on their habits to their treating oncologist.

After ten to twenty years of legal usage, then you might get a large enough sample to do an epidemiological study.

And hopefully by then they will realize that toking is as socially acceptable as tobacco smoking in public, so the stench will not invade my breathing space.

There are patients that have beat cancer and other llife threatening disease with cannabis, most have not let the Dr’s give them the poison called chemo, they went straight to the oil [sic] made from the plant tha heals most anything it somes in contact with.

You’ll have to excuse me if I wouldn’t touch some half-assed butane extraction with a windowpole.

the QUACKERY is highly reactive toxins, and x-radiation for cancer….. unless you want to kill EVERYTHING, which it does.

I assume by this you’re referring to current standard-of-care radiation therapy and chemotherapy. I’ll point out that there exists a large body of evidence, including large scale clinical studies, demonstrating the efficacy of these as treatments for cancer, alone or as an adjunct to other medical interventions such as surgery.

As no such body of evidence exists which suggests cannabis is effective at treating cancers, it’s pretty clear who’s promoting quackery here.

There is an official study showing cannabis extracts treated terminal acute lymphoblastic leukemia in the November 2013 Case Reports in Oncology issue (http://ncbi.nlm.nih.gov/pmc/articles/PMC3901602). It actually ruled out spontaneous remission and chemotherapy as potential causes.

I also suggest people check out CannabisExtractReport.com, which includes medical documentation of numerous terminal cancer patients in remission. I’m not going to argue this here, you can see the evidence for yourself and understand how real this is. Doctors, corporations, dispensaries, and small teams are all reporting these remarkable anti-cancer effects. See how deep the evidence is and judge it for yourself.

Cannabis is not some wonder drug, much as you’d like it to be. As noted above, it does promote psychosis in those predisposed toward it. Also, smoked cannabis, as with any smoked item, increases the risk of diseases of the lung, including cancer.

As to your study showing cancer risk, as also noted already, how exactly were these studies to be done when it was illegal? The study would also need to exclude those who smoke or have smoked tobacco products, since that would confound the results.

Finally, the whole plant would likely not be a particularly good medicinal treatment, since it has not only those compounds that would act as a treatment, but lots of other contaminants that would produce undesired side effects. I agree that it should be studied to see what active compounds can have a medicinal effect, but it is not a panacea.

Sigh. Anecdotes of cancer cures are not good evidence. I suggest that “Danman” and Justin search this blog for “Stanislaw Burzynski” and “success story” or search it for “cancer testimonial.” I’ve published more posts than I can remember describing how “cancer cure testimonials” almost certainly are not good evidence of a real cancer cure, coming, as they nearly all do, from misunderstandings about cancer.

A brief skim of Justin’s case report does not convince me there’s compelling dose-response data, contrary to the claim in the report. Also contrary to the claim in the report, spontaneous remission was not ruled out.

Daman, there’s a fairly large body of literature regarding the potential of targeting ERK/MAPK pathways to treat cancers, and several large pharamceutical companies have ongoing research programs attemtping to develop novel inhibitors, which have identifed a number of small molecule inhibitors representing different classes.

What suggests cannabinoids as a class are likely to perform as well or better than all other ERK inhibitors?

Come on people, stop with the idiotic paradigms …… Just because it`s illegal doesn`t mean a definitive link to cancer could not be established. That`s just silly talk.

I repeat;

There has been 50+ years of 100`s of millions of people smoking cannabis on a daily basis around the world. If the was any real threat of cancer, lung or otherwise, from cannabis, smoked, or eaten, the US Gov. would have been able to DEFINITIVELY prove it. Period.

It only took the gov, about 20 years to fully prove tobacco causes cancer, that despite the huge lobbying power of the cigarette industry.

They have not been able to prove a link to lung cancer because it does not exist.

Most advocates DON`T care about any more studies. The plant has been researched up one side and down the other. There was never any credible justification for the prohibition of cannabis in the first place, and there is sure no reason today.

Study it for another 80 years. I don`t care. But not under a federal ban.

And if your serious about research, a climate of deregulation is far more conducive than under a restrictive prohibition.

BTW, Daman, re: Dennis Hill? I’ll note that he was diagnosed with localized prostate cancer (Stage III–cancer local to the prostate and tissues near the prostate) around 2010. It’s hardly surprising that he’s still around: for patients with localized cancers adopting watch-and-wait strategies the 5 year survival rate is greater than 90%–there’s no reason to attribute his success to the cannabis oil (especially since his case represents an n of one.)

Does that mean that, in your opinion, the term “medical marijuana” is a farce? That the whole attempt to allow doctors to prescribe it and pharmacies/dispensaries to sell it has no provable medical justification? That really, the only reason that people advocate for “medical marijuana” is because they see it as either a stepping stone on the path to full legalization of recreational marijuana or as a path to de facto legalized recreational marijuana, with sufficiently compliant doctors writing scrips?

JGG said; “It’s hardly surprising that he’s still around: for patients with localized cancers adopting watch-and-wait strategies the 5 year survival rate is greater than 90%–there’s no reason to attribute his success to the cannabis oil.”

It wasn`t a watch and weight situation. His medical people had him setup for chemo. I think they gave him 6 months without treatment.

You think that just happens? Spontaneous remission, with terminal cancer?

Oh, I agree that the effects of smoked products on the lungs is complex, in terms of the degree of impact, but from what I understand, the effects of inhaling smoke from combusted items acts as an irritant on lung tissue, thereby increasing the risk of lung-oriented diseases compared to those who do not inhale that smoke.

@Danman

[The government has] not been able to prove a link to lung cancer because it does not exist.

Or they just haven’t spent the money to examine the question to the degree necessary. From studies that have been done, we actually don’t know what the dose threshold is for cancer risk. We do know that it does have a negative impact on airflow. (see, e.g., http://www.ncbi.nlm.nih.gov/pubmed/24384575) Certainly the risk of lung cancer is plausible.

Most advocates DON`T care about any more studies.

Thankfully, physicians and researchers do care about more studies so they can find out what it does and does not work for, at what doses, and what the side effects are.

Mephistopheles O’Brien said; …… “Does that mean that, in your opinion, the term “medical marijuana” is a farce? That the whole attempt to allow doctors to prescribe it and pharmacies/dispensaries to sell it has no provable medical justification?”

No doctors do not have the right to prescribe cannabis, any more than they have a right to prescribe carrots.

It`s a nutrient. And as a matter of fact if it`s not decarbed, it has no psycho-activity at all.

And as a matter of fact if it`s not decarbed [sic], it has no psycho-activity at all.

Oh, for G-d’s sake. You’ve already demonstrated that you think anything that mentions an endocannabinoid receptor is an automatic recommendation for smoking grass, even if it says the opposite (leaving aside any issue of getting it to the target in the first place).

Do yourself a favor and don’t bother with aimless digressions into decarboxylation of THC acid (which might be interesting in and of itself, although I’m not going looking), particularly given that you’re technically even wrong about this if one considers sedation a “psychoactive” effect.

No doctors do not have the right to prescribe cannabis, any more than they have a right to prescribe carrots.

The state of Illinois would disagree with that. Some states use the term “recommend” rather than “prescribe”, prohibiting sales to persons without a doctor’s recommendation. This provides an equivalent control to prescription, and I see minimal difference but you may believe otherwise.

Regardless, can I assume you agree with my basic conclusion – that backers of “medical marijuana” only really care about using that to gain effective legalization of recreational marijuana?

“It”? You’ve been running away from failed assertions willy-nilly. If you just had a claim that it is an illegitimate function of a state (construed broadly) to regulate The Herb, you could have said that and been done with it rather than making a sustained ass out of yourself.

Saying cannibis is a nutrient is a bit like saying my chair is a carbon atom.

There are nutrients in a cannibis plant (which you absorb by eating the plant, not smoking it). Macronutrients like protein and micronutrients like minerals and vitamins.

But just like my chair has a lot of things in it that are not carbon atoms any plant has a lot of things in it that are not nutrients.

You might say cannibis is nutritious as it has nutrients in it (assuming it has as much as any vegetable) but it is not a nutrient. Certainly not a single individual nutrients.

Although how many macronutrients and vitamins you get from a very tiny amount may not make a big difference in your diet. After all people don’t normally eat cups of the leaves, nor do they usually eat the seeds to get high, even though seeds tend to be nutrient dense to help the new baby plant grow.

Danman: No doctors do not have the right to prescribe cannabis, any more than they have a right to prescribe carrots.

Fun fact, the ‘carrots lead to better eyesight’ theory was actually just government propaganda. The British needed to explain how their planes kept shooting German planes down at night. While cannabis may have some medical benefits (improving appetite in certain patients) I doubt it’s a cure-all.

Danman’s whole point seems to be that he likes cannabis. Therefore all positive claims about it are true, and all negative ones are false. Everyone who disagrees with any claim he makes automatically agrees with everything that is incorrect.

A spelling troll, one of the lowest of the trolls. And yes, I usually end up committing a meme when using one.

At least my elementary school science and English teachers taught me the definition of nutrient and how it differs from a whole plant. I may have missed the spell the illegal drug properly lesson, but seems you missed a few more.

You might say cannibis is nutritious as it has nutrients in it (assuming it has as much as any vegetable)….

It’s not much of a vegetable* as far as I can tell, for which the only sensible interpretation is the leafy portion. All the claims seem to be more random burbling about endogenous cannabinoid receptors magically inducing a flood of antioxidants. (NN, of course, has an item about juicing it; I didn’t look to see whether it was lifted from the plethora of similar ones or vice versa.)

The crude leaf is basically rank as a foodstuff; the standard extraction for cooking purposes is to dry and then hold at a simmer in an oil–water mix, which limits the temperature and at least partially washes out the water-soluble components. The end product is waxy (which screws up standard baking recipes) and still desperately in need of flavor masking.

One can natter on all day about the EFA profile of the seeds, but this has very little to do with the medical claims, aside from being inversely correlated with the price of weed on the corner.

* Other than the time that Grady made a salad out of “wild parsley” on Sanford and Son.

Needless to say, Danman didn’t look too closely at his list (which he likely blindly picked up from, oh, say, cureyourowncancer-dot-org or “Herblover’s public profile”). Why anybody is supposed to be impressed by patent applications is an open question, but let’s consider one, No. 20100317729: “New Pharmaceutical Formulation comprising Cannabidiol and Tetrahydrocannabidivarin.”

Guess what THCV is? Yup, another antagonist. Paragraph 21 is rich:

In the applicant’s co-pending International patent application WO 2005/120478, the application describes that THCV could be used in place of THC. It has been subsequently found that this is not the case. THCV has been discovered to work as a CB1 receptor antagonist, which is completely opposite from THC which acts as a CB1 agonist.

Whatever, patent the whole lot. In any event, the thing is effectively a demonstration of the irrelevance of THC per se.

Narad said; ……. “In the applicant’s co-pending International patent application WO 2005/120478, the application describes that THCV could be used in place of THC. It has been subsequently found that this is not the case. THCV has been discovered to work as a CB1 receptor antagonist, which is completely opposite from THC which acts as a CB1 agonist.

Whatever, patent the whole lot. In any event, the thing is effectively a demonstration of the irrelevance of THC per se.”

All that means is that for cancer, strains with low THCV and THC should be used if possible. Or more likely if you have a high THC strain, the plant inherently will have less THCV.

And this is well supported by cannabis caregivers who report that no significant tumor reduction starts until they have high THC content oils/edibles for their patients.

Antagonist is bad, like Rimonabant. It inhibits receptor activity and causes side effects.

So, Narad the Savant, if you were formulating a cannabis medicine and you knew one of the naturally occurring cannabinoids in the plant (THCV) was an antagonist, possibly working against the goal of receptor activity, you would try and limit the percentage of the cannabinoid.

AdamG ….. “I can’t wait to hear how these ‘caregivers’ are measuring tumor size, let alone how and where they’re ‘reporting’ this data.”

Join some of the Facebook groups. Cannabis Oil Success Stories has 36,000 members. Many cancer CO success stories. Some patient post scans, others post reports, others just post their personal accounts … unless of course people just come there to lie and make stuff up.

Then why the fυck are you repeatedly citing shіt that crucially depends on endocannabinoid receptor antagonism to try to demonstrate specific anticancer effects from fυcking blowing weed, which really does not seem to have treated your head all that fυcking well, given this collection of pratfalls?

Well i am fighting lung cancer with chemo and cannabis oil. I have been on the oil for about 3 months now, the only side effect i have is hair loss and it is on its way back. Before the oil i could not sleep, had high blood pressure and terrible nose bleeds. I don’t know if it is a cure or not but the way i see it it sure can’t hurt any…Legalize Now!!

Although the joke* was indirectly about you, I will congratulate you on possessing adequate cognitive function to instantly know how many grams there are in an ounce while ciphering your way there and back.

Join some of the Facebook groups. Cannabis Oil Success Stories has 36,000 members. Many cancer CO success stories. Some patient post scans, others post reports, others just post their personal accounts … unless of course people just come there to lie and make stuff up.

A naive person who experience of the world has all been through a haze of marijuana smoke might well believe this false dichotomy, that either these patients are deliberately lyingor everything they are saying is true.

However, someone who does not understand why a patient with a serious medical condition might post a glowing testimonial claiming that their condition is much better and they’re almost certainly not going to die of it now, and actually believe everything they’re saying is the absolute and complete truth, and it doesn’t mean that their story is the absolute and complete truth, is a very naive person indeed.

Not that I’m aware of, thanks for asking. I learn better than many, less well than most. I do have many friends with various diagnosed learning disabilities (e.g. dyslexia); I’m sure they would appreciate your question as well.

THERE WAS NEVER A JUSTIFICATION FOR PROHIBITION IN 1937. AND THERE IS UNEQUIVOCALLY NO JUSTIFICATION TODAY.

This of course is completely different from the point you appeared to have been making, which is why I asked. You brought up a number of studies and patent applications regarding the medical use of cannabis and various compounds extracted from or derived from cannabis. You also brought up a number of testimonials for how well these products worked to treat various medical conditions. However, when people said that more research was needed to prove cannabis was effective as a treatment, you stated, “Most advocates DON`T care about any more studies.” This suggests to me that either the medical benefits are proven (which they aren’t, even according to many of the papers you cited) or that the whole discussion was unrelated the actual agenda.

I have no regard for any state, nor the federal ban. I, like millions around the world are going to do and use this plant however we choose, and for whatever we choose. Legal or not.

JGC said “I mean, you do have SOME actual evidence to support your claims…right?”

I thought you`d never ask ….

This is just one. Since the DEA is aware of some 10,000 peer reviewed studies, as of 2007, I`m quite sure there are thousands of repeats since 1974. Up until recently, under prohibition, no human trials have been conducted. But I think it`s safe to assume research, when possible, would certainly have been done with mice.

“It is becoming increasingly obvious that ceramide functions as a physiological signaling molecule, particularly with regard to the control of apoptosis, but also growth arrest, differentiation, cell migration, and adhesion. Activation of either CB1 or CB2 in glioma cells is associated with an increase in ceramide levels leading to the activation of the extracellular signal-regulated kinase (ERK) pathway via Raf-1 activation and p38 MAPK activation.14,106 Both these pathways ultimately cause apoptosis through caspase activation and/or cell-cycle arrest”

And I know this absolutely to be the case, first hand. A friend of mine has Non-Hodgkins Lymphoma, diagnosed early this year. Early stage, and slow growing according their medical peeps, thankfully. The PC of course said chemo. The friend said no I`m going to try cannabis oil first. If it doesn`t help then we`ll consider chemo. The PC was at first hesitant, but reluctantly gave the nod.

I told the friend about the THC ceramide connection and how it in theory could be used to plot cancer cell death during treatment with CO. I also suggested that if your insurance will pay for it then include it with other blood work. So over a month they did 3 draws and profiles, with ceramide included. The second draw, two weeks after they started the oil showed, according to their PC “significant increases in blood ceramide levels and a sharp drop in tumor markers”. The third test showed further increases in ceramide, but not as dramatic. They`re taking a high THC grain alcohol extract mixed with coconut oil taken orally 3x daily.

You do realize, don’t you, that your anecdote proves pretty much nothing about whether cannabis oil has any efficacy against lymphoma. Ceramide is not a clinically validated biomarker for lymphoma, Hodgkins or non-Hodgkins. Moreover, tumor markers often fluctuate. Moreover, you yourself say that this is an early stage, slow growing tumor, which are exactly the sort of tumors that can appear to be having a response when they are not.

I believe that they are passed around on their own special forums, and many just do not go back and actually read what was on the actual webpage.

I recently encountered someone who posted a link and then a quote. The problem was that the quote he posted did not match what was written on the actual link. He insisted that he did not delete any words and how could we call him out on it!

Then there are those that will read it and not understand the actual words. Much like the anti-vax folks that claim diseases were going away before the vaccine was available and their proof is a graph of mortality, not morbidity. Basic vocabulary fail.

Orac said; …… “Ceramide is not a clinically validated biomarker for lymphoma”

Duh … Why are you playing dumbass? Of course Ceramide is not a biomarker for lymphoma specifically! It`s a direct marker for apoptosis generally! Why in the f*ck are you pretending like you don`t understand how significant that is?

You REALLY can`t understand how the normal process of cell death, cancerous or not, must be a major factor in ones overall health? And that a non-toxic plant that helps the immune system identify and target unhealthy cells, even cancerous, for apoptosis, would, and in reality is, quite beneficial for a variety of maladies?

And I haven`t even gotten into CBD. Even MSM hack Sanjay Gupta is on the CDB bandwagon for epilepsy. Why do think there are so many states coming on board, with at least “CBD Only” laws? The state prohibition dominoes are going down one after another. Possibly half the US could be
either, medical, or legal after the national midterms.

THC kills cancer cells by driving ceramide synthesis and apoptosis. That is a fact. I`ve more than made my case. I`ve demonstrated that professional researchers know this to be fact, and are very interested. I`ve provided the testimony of a scientific professional and his experience curing his own prostate cancer, and very eloquently explaining the role of THC and ceramide in cannabis oil cancer treatment.

Game, Set, Match … you lose.

But you folks here at agendablog ……… oh I`m sorry, I meant scienceblog ….. can play ostrich as long you want.

What the hell do you think the ‘agenda’ actually is? I personally am completely in favor of legalization. I know it can work as I live somewhere where it’s already legal. I just believe we should take a measured approach when it comes to health claims regarding this natural product, just like I would for health claims surrounding any natural product, legal or otherwise.

AdamG said; ……. Do these people even read their own cites? For god’s sake the last line of the abstract is

“Overall, there is still a great deal of conflicting evidence around the future utility of the cannabinoids, natural or synthetic, as therapeutic agents”

Yawn …….. so what? That`s called scientific process. Every scientific theory has conflicting evidence. Edward Teller was said to be taking bets on whether they would incinerate the whole atmosphere, instead of just a piece of it at Alamogordo NM with the first A-test.

Uh, Danman, I’m a cancer surgeon AND a cancer researcher. I’ve forgotten more about apoptosis to make room for new science and new findings on apoptosis than you know now or will ever know. Back in the late 1990s, although I didn’t work on a ceramide-related project, others in the lab did; so I heard about it during lab meetings every week.

Also, when it comes to biomarkers, it doesn’t matter what the biomarker is. It still has to be validated in clinical studies to demonstrate that it has prognostic significance or predicts response to therapy. I don’t care that it’s a “general marker for apoptosis.” That matters not one whit unless it’s clinically validated.

Yes, but that’s not evidence that your particular theory is true. Don’t you see that I could use the same exact argument? “Well, there’s conflicting evidence like every scientific theory, but it’s definitely true without a doubt that there are no medicinal qualities to cannabis.”

Until there’s more research, we can’t make the kind of claims that you are. That’s why we need more research, particularly clinical trials. I believe that legalization, which should happen on its own merits, will lead to much higher quality research on this issue. That’s one of the reasons I support legalization.

What part of this do you have an issue with? Why is this unreasonable?

THC kills cancer cells by driving ceramide synthesis and apoptosis. That is a fact. I`ve more than made my case.

You posted a review article that (1) you immediately demonstrated you couldn’t even understand, (2) devotes a whopping two paragraphs to the ceramide angle, and (3) isn’t really particularly interested in THC in the first place:

Cannabinoids are not yet approved for the treatment of tumor progression, although their antitumorigenic effects have been known for over 30 years.[52] Cannabinol and Δ⁸-THC inhibited tumor growth in a mouse model of Lewis lung adenocarcinoma after 20 days of treatment, whereas cannabidiol or Δ⁹-THC failed to show any effect.[52] … In contrast, there are reports of pro-cancerous activity in breast, bronchial, hepatoma, and lung cell lines (Table 3).

You just see “cannabinoid receptor” and stupidly jump to “weed!” Agonist, antagonist, you can’t be bothered to sort it out.

within the first paragraph the author whips out the term “quackademic”.

You don`t see agenda there Adam?

First of all, that’s in reference to an entirely different subject (But I bet you have some…interesting thoughts about TCM too). Second of all, In the very next paragraph Orac clearly states his position with regards to legalization, namely that he’s for it. So again, what is the agenda here? Why do you refuse to concretely state exactly what this supposed ‘agenda’ is?

Chris said; ….. “I live in the same state as AdamG, and I voted for legalization. I don’t care if you partake as long as you follow two simple requests:

1. Do it far away from me so I don’t have to smell the stench of its smoke.

2. Don’t make medical claims that you cannot support with verifiable citations (this assumes that you have actually read and understood the full paper).

A) You need to pay attention, understand, and acknowledge, that for the medicinal properties that I have cited, and many others I have not, which are supported by ABUNDANT PEER REVIEWED SCIENCE, along with countless thousands of patient reports worldwide, SMOKING WILL NOT BE EFFECTIVE …… do understand that? The plant needs to be EATEN …… NOT SMOKED.

B) I can sympathize with your right to not inhale second cannabis smoke, but PLEASE stop being a jerk and bellowing on about it.

I’m sorry Danman, but you haven’t presented anything here that contradicts Orac’s claim that “it’s about belief first, and then trying to get the science to to support its magical properties.”

In fact, you’ve provided a perfect example. You presented a single article that, in it’s conclusion, states “Overall, the cannabinoids may show future promise in the treatment of cancer, but there are many significant hurdles to be overcome.”

All we’re doing is agreeing with the authors of your own citation. There are indeed many significant hurdles to overcome. You, however, have somehow twisted this article into definitive proof of medicinal benefit, without once acknowledging that more work is needed. In fact, you’ve basically condemned any further research. Isn’t this exactly the kind of thinking that Orac calls out?

Oh wow, this one’s in too deep. In addition to turning a list of “Peer-reviewed Articles on Cannabinoids and Cancer” into a list of 625 studies “in support” of the idea that “Cannabis Cures Cancer and whole lot of other diseases”

Danman even goes on to state

Cannabis is a medical panacea that you can grow in your own backyard.

and

The little “research” showing a link to mental illness was discredited, as lacking any credibility due to lousy scientific method, and small test numbers.

If that’s really how you feel about the currentstateof the literature you really have no business discussing this topic whatsoever. Please, I implore you, just give that last link a good read.

“You need to pay attention, understand, and acknowledge, that for the medicinal properties that I have cited, and many others I have not, which are supported by ABUNDANT PEER REVIEWED SCIENCE, along with countless thousands of patient reports worldwide, SMOKING WILL NOT BE EFFECTIVE …… do understand that? The plant needs to be EATEN …… NOT SMOKED. ”

THC kills cancer cells by driving ceramide synthesis and apoptosis. That is a fact. I`ve more than made my case.

Only if you ignore the studies that showed the opposite, such as the following mentioned in the review you cited:

Results are not clear-cut as to whether Δ9-THC causes pro- or antiproliferative effects in breast cancer cells. A study of Δ9-THC in MCF-7 and MDA-MB-231 cells (≤5 μM) reported proliferation in response to cannabinoid treatment. This finding is supported by the work of Takeda et al, who also documented a proliferative response to Δ9-THC in MCF-7 cells. […]
In mouse models of breast cancer, contradictory results have also been reported. […]
In a xenotransplant model of 4T1 paw cells in BALB/c mice, an increase in tumor size was recorded following Δ9-THC (25 mg/kg, intraperitoneally, 21 days). […]
One study using pure Δ9-THC at concentrations between 0.1 and 0.3 μM showed increased proliferation of NCI-H292 lung carcinoma cells. In the lungs of habitual marijuana smokers, significant increases in the proliferation marker Ki67 were observed along with changes in the expression of the epidermal growth-factor receptor, the human epidermal growth-factor receptor 2/neu receptor, p53, and DNA polyploidy. In hepatoma cells, Δ9-THC (2 μg/mL) induced the drug metabolizing enzyme cytochrome P450 1 A1, which is linked to the development of tobacco-related cancers. This induction effect was seen with both a marijuana-derived tar mixture and pure extracts of Δ9-THC.

This suggests to me that a great deal of caution is required, as blindly self-prescribing may result in making things worse. I do think cannabinoids have some very interesting and exciting properties, but we don’t really have much of a clue what is going on; sometimes cancerous cells are inhibited and sometimes stimulated, possibly dose dependently, but even that’s not clear. I think it is way too soon to start prescribing cannabis oil for cancer. If I were suffering from terminal cancer I might give it a try, but only after the failure of conventional cancer treatments that have been through clinical trials.

Danman, I note that in all the animal studies you’re linking to the animals aren’t being fed cannabis–they’re receiving synthetic cannabinoids by different routes of adminstration (e.g., in one of the Alzhiemer’s cites by direct injection into cerebral ventricles). There’s no evidence in your list supporting your claim “The plant needs to be EATEN …… NOT SMOKED.”

Perhaps you meant to say “The plant needs to be INJECTED DIRECTLY INTO YOUR BRAIN…… NOT SMOKED”?

Now as far as Cannabinoid Therapy having paradoxical results, indeed that can be the case. And it is not going work for all patients, all the time, with any cancer. I`m certainly not saying that, nor would the vast majority of even die-hard advocates. I agree with the author that, delivery, dosage, all sorts of details need to be worked out. But always I remind; Cannabis has no known fatal dose. The US gov. has repeatedly tried, and failed to define a lethal dose since forever. Period. That salient fact cannot be overstated. Is there even one conventional cancer regime that has no known lethal dose?

I think one problem actual cannabis oil/medicine patients could, and may in some cases be experiencing is Tumor Lysis Syndrome.

http://en.wikipedia.org/wiki/Tumor_lysis_syndrome
“In medicine (oncology and hematology), tumor lysis syndrome (TLS, alternative spelling tumour lysis syndrome) is a group of metabolic complications that can occur after treatment of cancer,[1] usually lymphomas and leukemias, and sometimes even without treatment. These complications are caused by the breakdown products of dying cancer cells and include hyperkalemia, hyperphosphatemia, hyperuricemia and hyperuricosuria, hypocalcemia, and consequent acute uric acid nephropathy and acute renal failure.”

I also would theorize that the rapid weight loss typically associated with cancer and/or cancer treatment, and breakdown of fatty tissues, and release of toxins within, must exacerbate the problem.

Which brings us back to the THC induced ceramide apoptosis bio-mechanism. A database of patients plotting ceramide blood levels throughout Cannabinoid Therapy will go a long way towards accurate dosing, and tumor status. Especially given often inaccurate conventional tumor markers.

danman, it’s pretty obvious you haven’t even bothered to check out any of those citations in that list. For example, just take a look at the last one on your first spam list, “Marijuana smoking and head and neck cancer.”

Do you think this study is “in support of cannabis medicine”? Think again. In fact, it’s a study examining the association between marijuana use and head and neck cancer RISK, nothing to do with actually TREATING the cancer.

Again, since it’s clear you haven’t actually examined most of these citations, can you point to a single one that demonstrates the CLINICAL efficacy of cannabis use? If not, don’t you agree that more research needs to be done?

That explains so much. Your livelihood is in no small way going to be effected. You have a severe conflict of interest here, Dr Orac. How can your position even remotely be taken as unbiased?

For you, and much of the medical/pharma complex, unless the internet is shutdown, there is going be a critical mass of public awareness reached about cannabis medicine/science. You can`t stop it. At that point the DEA/Gov. enforced monopoly the medical/pharma complex on curing is going to fall. And if our wholly corporately owned Gov. decides to try and get tough again, the people will merely return to the black market, or growing it themselves. It`s a genie that cannot be put back in the bottle.

And even if when the research chips fall as they may, and say cannabinoid therapy is shown be roughly as effective as conventional treatments why would one even consider expensive dangerous, toxic chemicals, and radiation bombardment vs. a totally non-toxic plant they can grow in the garden?

So how do you explain the studies that found THC-induced cancer cell proliferation and tumor growth? How is that consistent with, “THC induced Ceramide synthesis and cancer apoptosis” or with “confusing two different points”?

As for your claim that:

But always I remind; Cannabis has no known fatal dose. The US gov. has repeatedly tried, and failed to define a lethal dose since forever. Period. That salient fact cannot be overstated. Is there even one conventional cancer regime that has no known lethal dose?

That isn’t true. The fatal dose is very high compared to a therapeutic (or recreational) dose, but it certainly isn’t unknown. Oral delta-9 THC is actually more toxic (LD50 1,270 mg/kg) than oral acetaminophen (LD50 1,944 mg/kg), which kills hundreds of people every year through accidental overdose.

When you consider hash oil may contain up to 90% THC, a 70kg human might be expected to die after ingesting 5 ounces, which is very unlikely (not to mention unpleasant) but not impossible. IV or inhaled THC is even more toxic, with LD50 of 36–40 mg/kg.

You’re delusional if you think that somehow cannabis will totally upend the standards of care for cancer treatment.

say cannabinoid therapy is shown be roughly as effective as conventional treatments

That’s a pretty big “if” there, buddy. So you admit we don’t actually know yet? Don’t you think it’s unethical to tell people that cannabis is a “medical panacea” until we do in fact how effective it is?

AdamG said; ….. “danman, it’s pretty obvious you haven’t even bothered to check out any of those citations in that list. For example, just take a look at the last one on your first spam list, “Marijuana smoking and head and neck cancer.”

Do you think this study is “in support of cannabis medicine”? Think again. In fact, it’s a study examining the association between marijuana use and head and neck cancer RISK” …..

“Could smoking marijuana really prevent cancer? A recent study suggests that moderate marijuana use is associated with reduced risk of head and neck squamous cell carcinoma (HNSCC), better known as head and neck cancers. Numerous recent studies have shown that cannabinoids have anti tumor effects which most likely explains why marijuana smokers are less likely to get head and neck cancers.

(The Tashkin Study cited previously, shows that even HEAVY CANNABIS SMOKERS had slight decrease in those cancers)

Study conclusion:

Our study suggests that moderate marijuana use is associated with reduced risk of HNSCC. We found that moderate marijuana use was significantly associated with reduced risk of HNSCC. This association was consistent across different measures of marijuana use (marijuana use status, duration, and frequency of use). Further, we observed that marijuana use modified the interaction between alcohol and cigarette smoking, resulting in a decreased HNSCC risk among moderate smokers and light drinkers, and attenuated risk among the heaviest smokers and drinkers.”

Why do you persist in fallacies and mythology that have long ago been dispelled?

I repeat; Since at least 1970 the US Gov. has spent gozillions of dollars trying to demonstrate a cannabis cancer link. If there was, they would be singing it to the heavens on every public service commercial spot they could possibly buy.

Danman, now you’re trumpeting a study taht found smoking marijuana for 10 years or more is associated with a reduced risk of HNSCC, when previously you have insisted multiple times that smoking isn’t sufficient and it must be eaten instead to get enough THC exposure to cause significant ceramide synthesis? Clearly you’re just throwing random cites at the wall in the hopes a few might stick.

No that was a conservative prognostication. More likely is that Cannabinoid Therapy will be a FAR more effective AND SAFE first approach to most cancers.

And I`m betting these patients will really like the fact their hair won`t fall out, and they won`t spend several hours a day riding the porcelain bus, or have numerous, sometimes debilitating “forever” side effects, even with “successful” conventional treatment, like my in-law. And they`ll just love the fact they won`t have take more DANGEROUS TOXIC FDA APPROVED POISON to counteract the DANGEROUS TOXIC FDA APPROVED POISON to counteract more DANGEROUS TOXIC FDA APPROVED POISON.

And then they`ll be thrilled that instead of LOSING EVERYTHING when they can no longer afford the DANGEROUS TOXIC FDA APPROVED POISON, they can produce an effective, simple medication that at least will do no harm, just by growing a plant in their garden.

From the introduction, it might have been expected that a high CB1 tumour receptor expression would be beneficial to the patients, whereas the opposite was found to be the case, at least for the patients with stage II MSS tumours at surgery…. The question nevertheless remains as to why a high, rather than a low, CB1 expression should be associated with a poorer disease-specific survival. One possible explanation has been furnished by a recent study using cultured astrocytoma cells transfected with CB1 receptors [49]. In that study, the authors selected clones with different CB1 receptor expression levels and found that at a low receptor expression, the receptors coupled primarily to extracellular signal-regulated kinases, and that activation of the CB1 receptors led to apoptosis. In contrast, at a high level of CB1 receptor expression, activation of the receptors led additionally to the activation of the Akt survival pathway, and cannabinoids only produced apoptosis when this pathway was inhibited [49]. It is of course a long way from studies in transfected cells to the situation in solid tumours, but the postulation that a high CB1 receptor expression results in the switch from a pro-apoptotic to a predominantly pro-survival pathway would mean that the local endocannabinoid tone no longer acts to limit the damaging influence of the tumour but rather to exacerbate it and thereby result in a poorer prognosis for the patient.

You have provided papers that allow the inferences that THC (1) is atherogenic and (2) can promote tumor survival. Well done, Kumar.

That explains so much. Your livelihood is in no small way going to be effected. You have a severe conflict of interest here, Dr Orac. How can your position even remotely be taken as unbiased?

Actually, because I’m a surgeon, I’d be overjoyed if there were a nontoxic treatment for breast cancer that could replace chemotherapy, which I do not administer. Unless cannabis is truly a miracle cure that could cure cancer without surgery (and you’ve presented exactly zero evidence that it is) surgery will still be required in the treatment of breast cancer. As for my research, there are many other things I could turn my attention to related to cancer. Indeed, I’m already doing that, but mainly because I discovered that putting all my eggs in one basket (i.e., having too narrow a research focus) is a good way to have one’s lab go away when NIH funding gets as tight as it is.

But seriously, a variant of the “pharma shill” gambit? Really? It’s one of the lamest ad hominems there is. I could equally ask: How can your position even be remotely taken as unbiased, given that you so relentlessly have hijacked this thread with dumps of links that don’t prove your point?

For you, and much of the medical/pharma complex, unless the internet is shutdown, there is going be a critical mass of public awareness reached about cannabis medicine/science. You can`t stop it. At that point the DEA/Gov. enforced monopoly the medical/pharma complex on curing is going to fall. And if our wholly corporately owned Gov. decides to try and get tough again, the people will merely return to the black market, or growing it themselves. It`s a genie that cannot be put back in the bottle.

This is one that I like to call the fallacy of future vindication. It’s a fantasy antivaccine cranks revel in, and it’s not becoming of you to do the same.

And even if when the research chips fall as they may, and say cannabinoid therapy is shown be roughly as effective as conventional treatments why would one even consider expensive dangerous, toxic chemicals, and radiation bombardment vs. a totally non-toxic plant they can grow in the garden?

If that were the case, I would embrace cannabis. It’s not, at least not at the moment. There’s a corollary to your statement, though, whether you know it or not, though. It’s best expressed as a question: If the research chips fall where they may and cannabinoid therapy is shown not to have significant anticancer effects, will you abandon your advocacy of it? I’ve already said that I’m willing to go where the science leads, including if it leads to the conclusion that cannabis is the miracle treatment you seem to think it is. Are you willing to go where the science leads if it fails scientific testing?

With a whopping 19 Pubmed entries, 15 with Manuel Guzmán as an author? No, sorry. As I’ve already pointed out, THC itself doesn’t seem to be of much clinical interest in this regard. The receptor system itself? Sure. Weed? Not really.

Adam G beat me to it, but certainly nothing in listss of cites you spammed these comments with suggests “Cannabinoid Therapy will be a FAR more effective AND SAFE first approach to most cancers”.

And I will admit I am confused about one thing–you’ve claimed repeatedly that smoking marijuana isn’t sufficient to acheive a therapeutic exposure level of THC–that it (direct quote) “must be eaten to get enough THC to cause significant ceramide synthesis”.

Yet you’re now claiming that smoking marijuana reduces the risk of developing head and neck squamous cell carcinomas.

So which is it–is smoking it enough, or is eating it an absolute requirement?

Every single FDA approved poison that killed someone went thru clinical trials. In the long run clinical trials prove nothing, except how much pull a given pharma co has at the FDA.

Successful completion of clinical trials has nothing to do with “pull”, Danman, and clinical traisl are in fact very good at doing exactly what they’re designed to do: establishing therapeutic window, characterizing safety and demonstrating efficacy.

And they’re great at weeding out failures: for every drug that successfully completes Phase I, II and III clinical trials nine or more other candidates–typically with far greater evidence supporting their potential efficacy than marijuana or cannabinoids have to date–will fail to do so.

There’s certainly no reason to predict that if ever marijuana or marijuana derived cannabinoids ever reach a stage of development where beginning cinical trials is warranted they will turn out to be among the fortunate ten per cent which acheive approval, rather than among the other promising leads that failed to pan out.

How precisely would you consider it to be an “insubstantial” response to your own crowing about the GW patent applications, which promptly blew up in your face because you didn’t understand the difference between an agonist and an antagonist yet again? Remember, I’m the one who actually looked at the list.

It’s not my fault that you’ve been reduced to so much Jell-O with fresh pineapple when your attempts at intimidation didn’t play so well in front of an audience that’s used to posturing blowhards stopping by.

“A combined preclinical therapy of cannabinoids and temozolomide against glioma.”
– explores the combined use of TMZ and THC. says nothing about the efficacy of THC or cannabis on its own.

“Simultaneous measurement of three N- acylethanolamides in human bio-matrices using ultra performance liquid chromatography-tandem mass spectrometry.”
– describes a new method to measure the amounts of endocannabinoids in bodily fluids. has absolutely nothing to do with the clinical efficacy of cannabis. A few articles on the list appear to be like this…just measuring endocannabinoid levels.

“Modulation of the cannabinoid receptors by andrographolide attenuates hepatic apoptosis following bile duct ligation in rats with fibrosis.”
-invovles treating cholestatic liver disease with andrographolide, a natural derivative of a completely different plant with little relation to cannabis. it happens to mention the word ‘cannabinoid’ in the abstract so that’s how it probably got included in your list-of-articles-you-didn’t-read

I could keep going! Just admit it danman, most of your cites have little or nothing to do with your claim that natural cannabis is a “medical panacea.”

I’m aware our host doesn’t like this line of critique, but I’m a say what ya mean type of guy, so:

@Danman

“No clearly YOUR confused, or acting stupid.”

His confused what? He must possess a remarkable thing in this state of confusion, as it’s spelled out extra loud, perhaps for those who can’t read lowercase. Perhaps the acting skill you refer to following is employed to soothe the un-named possession beset with confusion.

Perhaps more cannabis will help you express yourself clearly. Can you copy paste another search result for that?

Don’t bother reading any of the articles from your search. It’s all Big Science tainted stuff, excepting a few sentences which you believe to mean “do moar dope, it’s good for you”.

I believe – and someone correct me if I’m wrong- but our gracious and magnanimous host only becomes ( righteously, I might add) peeved when his own words are unceremoniously critiqued for minor infractions.

@ shay:

it appears that Gergles has found a new home @ AoA where he serves as a consultant to the brain trust resident at that outlet.

Orac; …. “But seriously, a variant of the “pharma shill” gambit? Really? It’s one of the lamest ad hominems there is. I could equally ask: How can your position even be remotely taken as unbiased, given that you so relentlessly have hijacked this thread with dumps of links that don’t prove your point?”

They do prove my points, and you know it. Your in a state of deep denial.

Doctor, it is simply ludicrous to imply that an industry whose annual cancer treatment worth ALONE is somewhere around 3/4 of trillion annually worldwide would welcome a natural, non-toxic, plant based, and effective treatment with open arms. You have absolutely no integrity whatever if can come back and honestly say there are not intense economic interests involved, and being brought bear on legislators to protect the system.

They do prove my points, and you know it. Your in a state of deep denial.

Doctor, it is simply ludicrous to imply that an industry whose annual cancer treatment worth ALONE is somewhere around 3/4 of trillion annually worldwide would welcome a natural, non-toxic, plant based, and effective treatment with open arms.

That’s a straw man so friggin’ massive its lighting on fire with your burning stupid can be seen from space. I didn’t say the INDUSTRY would welcome it. I said *I* would welcome it. God, you’re dumb.

I think one problem actual cannabis oil/medicine patients could, and may in some cases be experiencing is Tumor Lysis Syndrome…..

“In medicine (oncology and hematology), tumor lysis syndrome (TLS, alternative spelling tumour lysis syndrome) is a group of metabolic complications that can occur after treatment of cancer,[1] usually lymphomas and leukemias, and sometimes even without treatment. These complications are caused by the breakdown products of dying cancer cells and include hyperkalemia, hyperphosphatemia, hyperuricemia and hyperuricosuria, hypocalcemia, and consequent acute uric acid nephropathy and acute renal failure.”

I also would theorize that the rapid weight loss typically associated with cancer and/or cancer treatment, and breakdown of fatty tissues, and release of toxins within, must exacerbate the problem.

Right, you cite a W—pedia article and follow it up with a random, completely unrelated “theory” that amounts to nothing other than the quack-classic “Herxing.”

Hint: TLS has nothing to do with “toxins,” unless you place potassium, phosphorus, and nucleic acids in this category.

Doctor, it is simply ludicrous to imply that an industry whose annual cancer treatment worth ALONE is somewhere around 3/4 of trillion annually worldwide….

For which you provide this:

“The economic toll from cancer is nearly 20 percent higher than heart disease, the second leading cause of economic loss ($895 billion and $753 billion respectively). This figure does not include direct medical costs, which would further increase the overall economic impact of cancer”

So, (1) you misread the text and confuse the heart-disease figure to obtain “around 3/4 of trillion [sic]” (2) from a source that explicitly is not talking about medical costs. In order to make a claim about medical industry profit.

Fantastic.

Do you know what these costs represent? Lost years of life and productivity, dumbass. You know, years during which the medical industry could be making money off of people.

@Danman, you need to work on your reading comprehension. More context from the site you yourself cited:

The report shows that cancer has the greatest economic impact from premature death and disability of all causes of death worldwide. The economic toll from cancer is nearly 20 percent higher than heart disease, the second leading cause of economic loss ($895 billion and $753 billion respectively). This figure does not include direct medical costs, which would further increase the overall economic impact of cancer.

See those words “premature death and disability”? That’s what they’re talking about in terms of economic impact: people who would have been productive tax-paying citizens, but died or became disabled, requiring support from others including governments, due to cancer. That is the cost of foregone productivity. That is *not* the cost of treatment. It even says so! You even quoted it saying so!

I didn’t say the INDUSTRY would welcome it. I said *I* would welcome it. God, you’re dumb.

Danman needs to study up on game theory. Every oncologist may be better off if all oncologists keep quiet about pot* than if they all revealed the secret, but any individual oncologist would be better off if he revealed the secret than if he didn’t.

*And of course all the other mutually exclusive 100% effective, inexpensive, all natural cures for cancer that various interested parties have touted.

“Cannabinoids, the active ingredients in marijuana, have dramatic effects on various organ systems. They exert their effects through two receptor types: CB1, primarily located in the brain, and CB2, primarily located in the immune system. Vertebrates also produce their own cannabinoid-like substances called endocannabinoids, including anandamide and 2-arachidonoylglyceral. Interestingly, some effects of endocannabinoids could not be explained by the signals through either CB1 or CB2. Recently, the orphan G protein-coupled receptor 55 (GPR55) was proposed to be an atypical cannabinoid receptor. In this issue of Oncogene, two groups demonstrated that GPR55 is expressed in various cancer types in an aggressiveness-related manner, suggesting a novel cancer biomarker and a potential therapeutic target.”

Well LW you should have read a bit more …. especially the part about “suggesting a novel cancer biomarker and a potential therapeutic target.”

Bugger me Danman, you are a prized idiot.

The therapeutic action on this novel target would be to down-regulate GPR55 or make it not respond to cannabinoids in an attempt to reduce its promotion of cancer cell proliferation. Exactly the opposite of what you are suggesting.

That would be because there was no link and it’s difficult for me to search on an iPhone with a barely functional Internet connection. Maybe it was in that list of links that showed up after scrolling thirty or so iPhone pages.

“God, you’re dumb” seems like the appropriate reply to all Danman’s drivel.

I have a friend who stays far away from marijuana. She grew up in the 1960s/70s with the “cool” parents that regularly toked with friends. She said they would have what they thought were “brilliant” conversations, and all she heard was nonsensical drivel.

She made the decision before entering high school that she preferred to keep her brain cells intact.

Recent reports indicate a higher frequency of brain infections with opportunistic amebae of the genus Acanthamoeba among immune compromised individuals, including AIDS patients. We have demonstrated, using a murine model of Granulomatous Amebic Encephalitis (GAE), that the major psychoactive and immune suppressive component in marijuana delta-9-tetrahydrocannabinol (THC) exacerbates infection by these amebae. Mice administered THC and infected with Acanthamoeba exhibited dose-related higher mortalities than infected vehicle controls. The greater severity of disease for THC-treated mice was accompanied by decreased accumulation of macrophage-like cells at focal sites of infection in the brain. Furthermore, THC administration resulted in decreased levels of mRNA for the pro-inflammatory cytokines interleukin-1 alpha, interleukin-1 beta, and tumor necrosis factor alpha for neonatal rat microglia co-cultured with Acanthamoeba. These results indicate a potential for marijuana to alter the capacity of brain macrophage-like cells to mount a full complement of immune responsiveness to brain infection by opportunistic amebae.

I think one problem actual cannabis oil/medicine patients could, and may in some cases be experiencing is Tumor Lysis Syndrome….

I also would theorize that the rapid weight loss typically associated with cancer and/or cancer treatment, and breakdown of fatty tissues, and release of toxins within, must exacerbate the problem.

OK, you have pulled TLS out of your ass and concluded that a “release of toxins” that you have also pulled out of your ass “must exacerbate the problem.” How? What “toxins”? What’s “exacerbated”? What happened to the “simple medication that at least will do no harm”?

The therapeutic action on this novel target would be to down-regulate GPR55 or make it not respond to cannabinoids in an attempt to reduce its promotion of cancer cell proliferation. Exactly the opposite of what you are suggesting.

That’s because he still thinks anything that has anything to do with cannabinoid receptors means “Weed!” He’s gotten this backward repeatedly.

You mean like taxol? Oh, the industry did welcome it. Natural, plant-based, and effective. I hope you can allow that a treatment which needs to kill cancer cells in order to be effective cannot be “non-toxic” ̶ it has to be toxic to the cancer cells.

Danman, considering that you cannot seem to understand why your arguments are not working on this crowd I’d ask what you’ve been smoking, but I guess given the topic that’s obvious.

“The therapeutic action on this novel target would be to down-regulate GPR55 or make it not respond to cannabinoids in an attempt to reduce its promotion of cancer cell proliferation. Exactly the opposite of what you are suggesting.”

Get a carrot and bugger yourself ….. The point I have all along stressed is that CB1 and CB2 are the receptors that are known to be involved with THC induced ceramide synthesis and apoptosis.

Nowhere did I imply that in order to treat cancer GPR55 should be up or down regulated.

“In every cell there is a family of interconvertible sphingolipids that specifically manage the life and death of that cell. This profile of factors is called the “Sphingolipid Rheostat.” If endogenous ceramide(a signaling metabolite of sphingosine-1-phosphate) is high, then cell death (apoptosis) is imminent. If ceramide is low, the cell is strong in its vitality.

Very simply, when THC connects to the CB1 or CB2 cannabinoid receptor site on the cancer cell, it causes an increase in ceramide synthesis which drives cell death. A normal healthy cell does not produce ceramide in the presence of THC, thus is not affected by the cannabinoid.

The cancer cell dies, not because of cytotoxic chemicals, but because of a tiny little shift in the mitochondria. Within most cells there is a cell nucleus, numerous mitochondria (hundreds to thousands), and various other organelles in the cytoplasm. The purpose of the mitochondria is to produce energy (ATP) for cell use. As ceramide starts to accumulate, turning up the Sphingolipid Rheostat, it increases the mitochondrial membrane pore permeability to cytochrome c, a critical protein in energy synthesis. Cytochrome c is pushed out of the mitochondria, killing the source of energy for the cell.”

Dennis was born in Houston Texas. He holds a Bio-Chemistry degree from the University of Houston. He attended post graduate studies at Baylor Medical School, Department of Physiology. Dennis worked in cancer research at M.D. Anderson hospital for ten years, and in hospital administration for another ten years after completing his M.B.A. studies at St. Edwards University, Houston. Dennis moved to California in 1993 to work in software engineering. He is currently working on software projects and teaching meditation.

You mean that Dennis Hill? Good thing he has an MBA, I bet he’s great at making money off fools like you. Speaking of shills, did you notice that the first thing you see on his website is an ad for his own tshirts?

He even has his very own page on whale.to! That’s how you know he’s legit.

Narad: …. Now you’re simply ignoring the fact that you’ve been provided with multiple examples of cancer cells that do exactly the opposite and trying to start over.

Wait a minute …….. so what your saying is Dennis Hill is a liar? Didn`t have cancer? Didn`t cure it with cannabis oil? Has no idea what he`s talking about?

I’m talking about you, jackass. You were trying to reboot the screaming failure of link dumps by cycling back to where you started.

Narad ….. “The cancer cell dies, not because of cytotoxic chemicals, but because of a tiny little shift in the mitochondria.”

I hate to break this to you, but this is the effect of a cytotoxic chemical.

….. so your saying the man did chemo? The man is a liar?

Maybe he’s an imbecile. Nobody’s shown whether the intrinsic or extrinsic pathway is involved even if the ceramide routine were to hold water, but do you “think” that using a chemical to get mitochondria to disgorge cytochrome c to kill their cells is some magic thing that only the Goddess Herb can do? Oops.

That exactly what I thought. Too f*cking cowardly to backup your own convictions.

Oh, dear, Bitsy does have some impulse control issues, doesn’t he?

I`m done here. I`ve made my points.

Do stick the flounce. And see if you can trade a bag for some apostrophes.

First of all, to those who posted about prohibition: the belief that prohibition was a total failure is oversimplified and as a group of critical thinkers, you can do better. Look up the research. Just because it’s part of our national mythology doesn’t make it true.

Secondly, and more importantly, thank you for the interesting discussion. My dh has stage iv lung cancer (adeno). He had a complete response to first line doublet chemo and is currently NED. I’m sure glad he did the govt. approved “poison”. We are one of the lucky 1-3% with a complete response, but I know many, many more who’ve extended their lives and eased their symptoms with chemo.

I look forward to reading more and await your article on cannabis oil and cancer. I’m looking for ideas when chemo options run out as they tend to do with stage iv.

PollylovesJoe: First of all, to those who posted about prohibition: the belief that prohibition was a total failure is oversimplified and as a group of critical thinkers, you can do better. Look up the research. Just because it’s part of our national mythology doesn’t make it true.

During Prohibition, consumption of alcoholic beverages actually rose, the number of deaths related to alcohol poisoning rose, organized crime expanded and became more deadly than ever, and a number of cities openly flouted federal law. To me, that smacks of failure. If Prohibition had any actual success, I’m unaware of it. I think you might be using a different dictionary or history than the rest of us use.

PGP, you’ve unsurprisingly fallen for the “national mythology” just as PollylovesJoe pointed out. A simple read of the wiki on US Prohibition would have told you that your claim above is not based in reality, and would’ve lead you to this source: http://www.nber.org/papers/w3675.pdf

As Hilll hasn’t offered any evidence that the cannabis oil protocol he followed caused his cancer to remit bu seems to simply be embracing a post hoc ergo procter hoc logical fallacy (seasoned liberally with “What else could it be?”), and given the five year survival rates of untreated patients presenting with the same stage of prostate cancer, no: I don’t believe his claim that his cancer was cured by cannabis oil–he’s given me no reason to.

Cirrhosis of the liver rates went down which does tend to indicate an overall decline as it tends to be dose dependent..

In any case I think the social issues with crime were much more what any failure was about even if the number of people who drank went down or the number of drinks per person per year went down.

And both those numbers, IMO could go down substantially and alcohol poisoning go up. Just the standard issue human foolishness of the I can’t get it often so when I get it I better binge on it variety added to changes in distillation (or just greater variation in home distillation rather than large scale industrial) could have you end up with more poisoned people (assuming if those stats are purely ethanol and not including people drinking impure spirits) even with less overall drinking.

Cirrhosis of the liver rates went down which does tend to indicate an overall decline as it tends to be dose dependent..

The claim is for death rates, not prevalence. Take a look at Figures 2 and 3 in Dills & Miron; apparently, Prohibition magically immediately fixed the number of cirrhosis deaths but didn’t cause any further decrease. The hypothesis of simple dose dependence is also belied by the the other-country data.

I’m not going to go through and look at how much they massaged the data, but I’d be a lot more confident in this conclusion if it were coming from epidemiologists rather than economists.

Kaymarie: There was a lot of alcohol poisoning during Prohibition, usually from impure spirits or people trying to drink alcohol not intended for human consumption (like wood or rubbing alcohol). Maybe the rates of cirrhosis went down because heavy drinkers either tried to extend their stock by drinking less, or they succumbed to other causes.

AdamG: Did you ever read Last Call? Or other actual historical accounts of Prohibition? I’d rather rely on historians than economists, who are to a man ignorant of history and tend not to get out in the fresh air.

You are speaking very well from a scientific,western medicine model. Marijuana is an herb and so expands out from that model and can not be understood through the limited double blind placebo test process.

Traditional herbalism has always included relationship in its equations, as relationship plays a big part in health and wellness. The relationship between practitioner, patient and tool used is multidimensional and can thus far is not well addressed by western model research, so those that think in that model, can not truly appreciated the multidimensional benefits of not just “weed” as you stated, but all weeds.

The idea that just because you can standardize a chemical to induce a response on a percentage of patients and may cause a multitude of side effects, makes it better to take than an herb that has constituents from nature and recognized by the body and used for centuries, so the body knows what to do with it and is in relationship, for me doesn’t work. I have studied in traditional herbalism many years and hold a masters in herbal studies (a western perspective model). I love the science of phyto chemicals and all the left brained stuff. But it is only one side of the equation. Herbalism opens to the left brain too, relationship, change, growth, evolution, where most of us live and at least have experience. We don’t have double blind placebo tests to help us navigate. But we do have herbs, the plants that have accompanied us for ever. Thank goodness.

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